Wandering in dementia
Wandering, in persons with dementia, is a common behavior that causes great risk for the person and concern for caregivers. It is estimated to be the most common type of disruptive behavior in institutionalized persons with dementia. Although it occurs in several types of dementia, wandering is especially problematic in persons with Alzheimer's disease (AD). This is because AD frequently produces impaired memory: persons with impaired memory are likely to become disoriented and lost simply because they do not recognize where they are nor remember how they came to be there. Elopement Unattended wandering that goes out of bounds, a behavior known as elopement, is a special concern for caregivers and search and rescue responders. Because elopement often follows from a combination of wandering and sundowning, it typically results in the person being lost out of doors at night, dressed inappropriately, and unable to take many ordinarily routine steps to ensure their personal safety and security. This is a situation of great urgency, and the necessity of searching at night imposes added risks on the searchers. In some countries the social costs of elopement, already significant, are increasing rapidly. A SAR mission lasting more than a few hours is likely to expend many hundreds to thousands to tens of thousands of skilled man hours and, per mission, those involving subjects with dementia typically expend significantly more resources than others. Assessment Assessment of a person's risk of wandering often is neglected. A review of medical records of 83 persons with dementia resident in Los Angeles, California found that only 8% of the records included a wandering risk assessment. Assessment can be performed by a social worker. In the United States the Alzheimer's Association has developed a program called "Safe Return", that includes assessment tools. An assessment tool designed for use in nursing homes is the Revised Algase Wandering Scale-Nursing Home Version (RAWS-NH); this tool may be suitable for use also in assisted living facilities. Prevention Methods used to prevent wandering, or simply to reduce the risk of wandering out of bounds, include: drugs, physical restraints, physical barriers, 24-hour real time surveillance, and tracking devices. All of these methods have ethical issues and one, use of physical restraints, is widely considered to be inhumane. Tracking devices of several kinds have been evaluated. Much of the literature on wandering concerns persons resident in institutions. Studies on wandering from private residences are insufficient for comparison of prevention via drugs versus other methods. The risk of wandering can be reduced by several low-tech and minimally intrusive techniques, including: placing a visual barrier such as a curtain across a doorway. Technology In other efforts to help mitigate liability, Long Term Care and Assisted Living Facilities may use radio frequency (RFID) products to protect their residents. A resident wears a wrist or ankle transmitter. This RFID tag can be read by receiving antennas, which are placed usually at door or hallway locations that are deemed likely routes of escape and will need monitoring. The system will then either sound an alarm or lock a door when a door system reads a resident transmitter worn by a resident that is at risk for wandering. This helps prevent an elopement as staff can be notified by alarms at the door, pocket pagers, and email. A well trained staff will be able to quickly find the person at risk and keep them safely inside. Newer versions of this equipment have become more advanced. The newest types of systems may have the ability to: identify a RFID tag by a specific resident and forward that name to the staff; give staff a last known location of the resident; show a photo of the resident at the staff station with a mapped out door location; report the the frequency, times and severity of the incidents; and finally, integrate with other access control sytems, HVAC, fire alarm equipment and phone equipment. The reason this type of system seems to be preferable is that it helps monitor those at risk for wandering and elopements while not infringing on the freedom of other residents or visitors to a facility. While many companies compete in this market, the two oldest and most well known companies that provide this equipment are generally considered to be RF Technologieshttp://www.rft.com and their Code Alerthttp://rft.com/solutions/codealertwandering/ brand and Stanley Senior Technologies http://www.seniortechnologies.com/default1024.asp with their Wanderguardhttp://www.seniortechnologies.com/products/wanderguard/default.asp?type=longterm brand. The companies have been around so long and are in so many facilities that regionally their brands have become synonymous with the generic term for this type of equipment. References *PMID 15014607 *PMID 14645806 *PMID 10513031 Category:Alzheimer's disease Category:Rescue